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412 Masochistic Character and Sadomasochism, Clinical Strategies – 4 seminars

Seminar Leader: M. A. Fitzpatrick Hanly, PhD

Course Description

This course will teach candidates to define and describe the many-faceted concept of masochism, so that they can identify, recognize, assess, and formulate masochistic character, and can identify sadomasochistic transferences and dynamics so as to effect change. Clinical material will be presented to facilitate the application of theory and concepts to the psychoanalytic therapeutic process. Developmental challenges and trauma can lead to excessive masochistic defenses, such as self-defeating or self-sacrificial behaviors and identification with the aggressor, which need careful attention in the therapeutic process, and which are ameliorated by understanding, containment and interpretation over time.

Course Objectives

Candidates will learn how to:

  1. Use the major diagnostic category (1.3) (Masochistic/Self-defeating Personality, McWilliams, 2011) to recognize self-sabotage as linked to specific (1.3) knowledge of psychopathology, that is, recognition of symptoms, inhibitions, and anxieties: the turning of aggression back on the self due to fear of aggressive impulses to the primary objects, the introjection of aspects of the loved hated lost object, excessive self-reproach, self-sacrifice, hyper-responsibility, unconscious need for punishment due to unconscious childhood sadistic fantasies;
  2. Formulate an assessment, using key concepts of psychoanalysis (4.5) to identify sadomasochistic dynamics and to interpret the typical defenses of masochistic character: introjection, denial, reaction formation, and projection;
  3. Recognize contextual and systemic factors that facilitate or impair human functioning (1.1), specifically normal and maladaptive sadomasochistic functioning, and to interpret (1.1) the developmental and (1.2) traumatic factors in the difficulties so as to effect change.
  4. Maintain professional psychoanalytic boundaries (4.2) under the pressure of a patient’s provocative masochistic behaviors and attitudes, by interpreting the associative process and the transference;
  5. Facilitate change (1.2) through containing and interpreting, in part through employing effective skills in observation of self;
  6. Establish and maintain a therapeutic relationship informed by the theoretical framework of psychoanalysis(1.2): a) how to exercise of receptivity, respect, and empathy (4.2) under the pressure of counter-transferences to sadomasochistic transferences, keeping the non-judgmental stance, which is the psychoanalytic attitude; b) how to maintain a safe and effective use of the self (4.3) in the analysis of the masochistic character, while the provocation (subtle or overt) of sadistic response from the therapist is expectable with masochistic dynamics; and c) how to use psychoanalytic theoretical framework to anticipate and respond appropriately to expression of intense emotions within masochistic character and to facilitate understanding and change (4.5).

Seminar 1

Review of Psychoanalytic theories of masochism, causation, and treatment

The goal of this seminar is to review the psychoanalytic theories of masochism and sadomasochistic dynamics in papers, which best summarize the clinical understanding of the pathologies, with their contextual and systemic factors, and effective treatment approaches, developed through a century of study.

Required Readings

Loewenstein, Rudolph (1957). A contribution to the psychoanalytic theory of masochism. In Essential Papers on Masochism (1995, pp. 35-61). New York, NY: New York University Press.

Meyers H. (1988). A consideration of treatment techniques in relation to the functions of masochism. In Glick, R.A. and Meyers, D. (Eds.), Masochism: Current Analytic Perspectives. Hillsdale, NJ: The Analytic Press.

Seminar 2

Masochistic defenses: clinical examples and interpretive strategies

The goal of this seminar is to study the successful psychoanalytic treatment of a patient with a severe masochistic disorder, understood in classic and still current diagnostic formulations, treated at Austen Riggs Hospital. Masochistic character is understood as a characterological expression of a masochistic development, a complex configuration designed, not primarily to encompass an unconscious need for punishment, but to maintain a balance between primitive libidinal and aggressive drives, under the pressure of certain parental failures, with at least four specific mechanisms of defense: introjection, denial, reaction formation, and projection. The seminar also studies primitive infantile experiences as they enter the transference and countertransference and are made available for working through.

Required Readings

Brenman, M. (1952). On teasing and being teased. Psychoanalytic Study of the Child, 8, 264-285.

Rosenfeld H. (1988). On masochism: A theoretical and technical approach. In R.A. Glick & D.I. Meyers (Eds.), Masochism: Current Analytic Perspectives, Hillsdale, NJ: The Analytic Press.

Seminar 3

Masochistic character: aetiology in development and trauma, therapeutic strategies

This seminar will focus on the understanding of the genesis of the masochistic character in the developmental stages with two extended clinical examples and technical recommendations for treatment and the understanding of the effects of two kinds of trauma on masochistic elements in psychic functioning, with the psychoanalytic technique of facilitation of fantasy in the associative process, interpretation of dreams and transference as a major element in elaboration and working through.

Required Readings

Auchincloss E. & Samberg, E. (Eds.). (2012). Masochism. In Psychoanalytic Terms and Concepts. New Haven, CT & London: Yale University Press (and American Psychoanalytic Association).

Brenner, C. (1959). The masochistic character: genesis and treatment. In Essential Papers on Masochism (1995, pp. 360-382). New York, NY: New York University Press.

Grossman, W. (1991). Pain, aggression, fantasy, and concepts of sadomasochism. In Essential Papers on Masochism (1995, pp. 125-150). New York, NY: New York University Press.

Seminar 4

Masochistic excitement and perverse sadomasochism

The goal of this seminar is to understand how problems with aggression and early narcissistic problems, as well as splitting and sexualized scenarios, are part of the current definitions of perversion. Several vignettes of male and female patients demonstrate debts owed to Freud’s theories and the way in which current thinking differs. The papers teach that the understanding of the transference-countertransference picture is central in facilitating changes in the patient’s management and control of excitement. The papers will show how a deep understanding of the impact of power dynamics on the psychoanalytic process with perverse sadomasochism, is central to the therapeutic efficacy.

Required Readings

Kulish, N. & Holtzman, D. (2014). The widening scope of indications for perversions. Psychoanalytic Quarterly, 83(2), 281-313.

Coen, S. (1992). The excitement of sadomasochism. In Essential Papers on Masochism (pp. 383-402). New York, NY: New York University Press (1995).

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